For people diagnosed with alcohol use disorder (AUD), the traditional therapeutic goal has long been total abstinence. It’s a time-tested approach that, for many people, continues to be the best solution. It is, however, no longer the only solution. Increasingly, research is showing that substantially reducing alcohol consumption short of abstinence can yield meaningful improvements in health and functioning, and abstinence may not be necessary for all individuals, according to Yale addiction specialist Stephanie O’Malley.In current AUD treatment, many clinicians now tailor treatments that fit individuals and their specific needs, explained O’Malley, the Elizabeth Mears and House Jameson Professor of Psychiatry at Yale School of Medicine. The biggest obstacle, however, continues to be getting people to seek help in the first place — something that O’Malley says the shift in treatment goals may help.
Our hope is that if there is greater recognition that reductions in drinking are an acceptable outcome for many people, then more people will access treatment.
“Unfortunately, rates of treatment-seeking are very low, and I think it’s partly because many people assume that abstinence is the only goal in treatment,” O’Malley said. “Our hope is that if there is greater recognition that reductions in drinking are an acceptable outcome for many people, then more people will access treatment.”O’Malley is on the editorial board of JAMA Psychiatry and is a past member of the Data and Safety Monitoring Board for the Clinical Trials Network of the National Institute on Drug Abuse. A consultant to pharmaceutical companies, O’Malley is also a member of the American Society of Clinical Psychopharmacology’s Alcohol Clinical Trial Initiative, a public-private partnership working to improve methods for clinical trials. Last year, O’Malley co-authored a review of 34 published papers which concluded that reducing alcohol consumption by at least one or two identified World Health Organization (WHO) risk-drinking levels is associated with a cascade of improvements in health and functioning. The WHO risk-drinking levels include very high, high, moderate, low, and no risk (abstinence) alcohol consumption, based on average drinks or grams of alcohol consumed, with different cut-offs specified for men and women. “While abstinence represents the lowest risk, the finding that a large proportion of individuals with AUD can achieve and maintain clinically meaningful reductions in their drinking short of abstinence is encouraging,” O’Malley said.In a recent interview, O’Malley discussed evolving treatments for alcohol use disorder, the promise of new medications, and why not everyone needs to fully abstain.This conversation had been edited for length and clarity.
